STRONGSVILLE, Ohio -- With a decisive vote on his health-care overhaul possible within days, President Obama declared repeatedly Monday that "we need courage" from elected leaders to pass the far-reaching package.

Making an impassioned pitch in a part of the country where unemployment runs high and insurance coverage is uncertain, Obama said in a speech at a senior center here, "I don't know about the politics, but I know what's the right thing to do."

Nearly shouting as the crowd cheered, he added: "And so I'm calling on Congress to pass these reforms -- and I'm going to sign them into law. I want some courage. I want us to do the right thing, Ohio. And with your help, we're going to make it happen."

Obama depicted a health-care system of rising costs and declining coverage, with millions of Americans unable to afford the premiums for quality care. He implored his audience to keep in mind, "There but for the grace of God go any one of us."

For his third campaign-style speech in eight days, Obama chose a Cleveland suburb that voted for Sen. John McCain (Ariz.), his Republican opponent, in 2008. His traveling party from Washington included liberal Rep. Dennis Kucinich (D-Ohio), who has said he will vote against the health-care bill because it does not go far enough.

As Obama addressed more than 1,400 people in the Walter F. Ehrnfelt Recreation and Senior Center, the crowd often roared its approval. But he also heard catcalls of, "What's your plan?" and "Jobs!"

In Washington, the House Budget Committee voted Monday to advance the legislation toward a floor vote later this week. The panel approved a package of fixes to the overhaul by a vote of 21 to 16. Two Democrats sided with all 14 Republicans in voting against the plan.

Democratic leaders, meanwhile, continued their efforts to pull together enough votes to push the package through the House, as Republicans vowed to keep fighting to kill the legislation and drew attention to House Democrats said to be planning to vote against it.

Rep. Eric Cantor (R-Va.), the House Republican whip, asserted in a statement that Americans "prefer incremental health-care reforms to strengthen the system we have," rather than what he called "the trillion-dollar health-care overhaul complete with kickbacks that passed the Senate on Christmas Eve." He demanded that all members of Congress "go on the record and make clear whether they support the Senate bill or not as is."

Obama focused his pitch for a health-care overhaul on the story of Natoma Canfield, a 50-year-old Ohio cancer survivor and self-employed house cleaner who struggled to maintain health insurance as her premiums skyrocketed. Last year, her insurance company raised her premiums by more than 25 percent, and she had to pay more than $10,000 in premiums and out-of-pocket costs for $900 in insurer-paid care, only to receive notice at the end of the year that her premiums would rise again by more than 40 percent, Obama told the audience.

Unable to afford the insurance any longer, she was forced to give it up and gamble that she would stay healthy, and she wrote a letter to Obama explaining her plight. Then, last week, her worst fears were realized when she collapsed, was rushed to a hospital and was diagnosed with leukemia, Obama said. Canfield had been scheduled to introduce Obama at Monday's appearance but could not make it because she was still in a hospital bed, racked with worry about her illness and the costs of fighting it, the president said.

"I'm here because of Natoma," Obama told the crowd. "I'm here because of countless others who have been forced to face the most terrifying challenges in their lives with the added burden of medical bills they can't pay. I don't think that's right. . . . That's why we need health-insurance reform right now!"

Obama defended his health-care proposal against Republican critics who contend that it will weaken Medicare, which he called "the most insidious argument" advanced by "opponents of reform."

Addressing seniors in the audience, Obama said, "There is no cutting of your guaranteed Medicare benefits, period. No ifs, ands or buts. This proposal makes Medicare stronger, it makes the coverage better, and it makes the finances more secure. And anybody who says otherwise is either misinformed or they're trying to misinform you. Don't let them hoodwink you."

He said his proposals would end "the worst practices" of health-insurance companies, reduce most people's premiums, cut the federal deficit by up to $1 trillion over the next two decades, add nearly a decade of solvency to Medicare, and close the gap in prescription drug coverage known as the "doughnut hole."

He put the cost of the overhaul at "about $100 billion per year" but said most of the money would come from "the nearly $2.5 trillion a year that Americans already spend on health care." The bottom line, he said, is "our proposal is paid for."

Obama called the status quo "simply unsustainable" and drew the contrast favored by Democratic leaders as they try to wring the final votes for passage from fence-sitting colleagues on Capitol Hill.

"We know what will happen if we fail to act," Obama said, arguing that costs will continue to rise and families and businesses will shed coverage. He cited a nonpartisan study released Sunday that said health-insurance premiums for individuals and families would more than double over the next decade without reform, with family policies topping $25,000. "Can you afford that?" he asked the audience.

Democrats also maintain that a defeat in Congress will hurt incumbents with voters frustrated by the lack of action on a range of issues.

Saying that Congress "owes the American people a final up-or-down vote," Obama declared: "It's time to vote." He dismissed talk of politics, poll numbers and the November midterm elections.

As Obama was speaking about the congressional battle, a woman in the crowd called out, "We need courage." The crowd cheered, and Obama departed from his prepared remarks to repeat her words.

"We need courage," he said three times to applause.

But dozens of protesters, taking a very different view, stood in a cold drizzle, waving signs at passing cars as they awaited Obama's motorcade.

"We the people say no to Obama care," read one sign.

"Stay out of my health care," read another.

"It's going to cost too much money. I think it will increase the deficit," said Chris Matthews, who answered an e-mail appeal from the Portage County Tea Party. He believes Obama's plan will pass "because he'll give a bunch of sweetheart deals to people who are holding out."

Melissa Seimetz, whose sign said, "Give us liberty, not Obama Care, also thinks Obama is likely to get enough votes: "I fear that it will. I hope it doesn't." Wearing a "Don't Tread on Me" T-shirt, the insurance company worker said Obama represents "radical socialism."

Although she is worried that the reform would allow federal money to help pay for abortions, Seimetz said she is less angered by the details of Obama's health-care proposals than what she called "the way it's happening." She said the Democrats should not be "pushing it through like this."

Inside the community center, where McCain and his running mate, former Alaska governor Sarah Palin, made a campaign appearance in 2008, many in the crowd shouted their approval.

"What do we want? Health care! When do we want it? Now!" went the call and response before Obama started speaking. "Yes, we can!" much of the crowd chanted, reprising the president's campaign mantra. Yet, in a sign of Obama's challenges ahead, not everyone joined in.